Lam Kayan, Sjauw Krischan D, Henriques José P S, Ince Can, de Mol Bas A J M
Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Clin Res Cardiol. 2009 May;98(5):311-8. doi: 10.1007/s00392-009-0006-4. Epub 2009 Mar 12.
Circulatory support during percutaneous coronary intervention (PCI) in patients with ST-element elevation myocardial infarction (STEMI) aims at maintaining hemodynamic stability and organ perfusion. However, continuous flow pumps may interfere with the normal pulsatile circulation and the microcirculatory function. Sidestream dark field (SDF) imaging allows the visualization of microvascular structure and function of tissue and may provide information regarding the efficacy of the circulatory support.
Sidestream dark field was used to study the sublingual microcirculation (MC) in six anterior STEMI patients treated with PCI; three patients received Impella LP2.5 percutaneous left ventricular support (Impella group) and three patients received no support (control group). MC was assessed at baseline, at 24, 48 and 72 h after PCI. Data were analyzed using a validated scoring method and the microvascular flow index (MFI) and perfused vessel density (PVD) were calculated. MC of three healthy controls was used as normalized standard.
Normal MC depending on both functional capillary density (PVD) and flow velocity or quality (MFI), as observed in healthy controls, was only achieved in the Impella group and paralleled improvement in LV function. Functional capillary density in the control and Impella groups were respectively equal and above the level of healthy controls. The quality of microcirculatory flow only in the Impella group reached values of healthy controls.
Microcirculation assessed by SDF improved in STEMI patients treated with the Impella LP2.5 to levels observed in healthy persons and remained suboptimal after 72 h in patients without support. Sublingual SDF to assess MC may serve as a monitor of effective myocardial recovery after PCI and optimization of organ perfusion.
ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）期间的循环支持旨在维持血流动力学稳定性和器官灌注。然而，连续流泵可能会干扰正常的搏动循环和微循环功能。侧流暗场（SDF）成像可使组织的微血管结构和功能可视化，并可能提供有关循环支持效果的信息。
采用侧流暗场研究6例接受PCI治疗的前壁STEMI患者的舌下微循环（MC）；3例患者接受Impella LP2.5经皮左心室支持（Impella组），3例患者未接受支持（对照组）。在PCI术后24、48和72小时以及基线时评估MC。使用经过验证的评分方法分析数据，并计算微血管血流指数（MFI）和灌注血管密度（PVD）。将3名健康对照者的MC用作标准化标准。
如在健康对照者中观察到的那样，正常的MC取决于功能性毛细血管密度（PVD）以及流速或质量（MFI），仅在Impella组中实现，并且与左心室功能的改善平行。对照组和Impella组的功能性毛细血管密度分别与健康对照者相当且高于其水平。仅Impella组的微循环血流质量达到了健康对照者的值。
用Impella LP2.5治疗的STEMI患者中，通过SDF评估的微循环改善至健康人观察到的水平，而未接受支持的患者在72小时后仍未达到最佳状态。舌下SDF评估MC可作为PCI术后心肌有效恢复和器官灌注优化的监测指标。
